Microvascular endothelial dysfunction is associated with albuminuria and CKD in older adults

Background Impairment in glomerular endothelial function likely plays a major role in the development of albuminuria and CKD progression. Glomerular endothelial dysfunction may reflect systemic microvascular dysfunction, accounting in part for the greater cardiovascular risk in patients with albumin...

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Vydané v:	BMC nephrology Ročník 17; číslo 1; s. 82
Hlavní autori:	Seliger, Stephen L., Salimi, Shabnam, Pierre, Valerie, Giffuni, Jamie, Katzel, Leslie, Parsa, Afshin
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	London BioMed Central 13.07.2016 BioMed Central Ltd Springer Nature B.V
Predmet:	Acute coronary syndromes Aged Albuminuria Albuminuria - diagnosis Albuminuria - epidemiology Albuminuria - physiopathology Analysis Blood Flow Velocity - physiology Blood pressure Cardiovascular disease Care and treatment Chronic kidney failure Clinical Research Complications and side effects Consent Cross-Sectional Studies Data analysis Data collection Diabetes Endothelium Endothelium, Vascular - physiopathology Funding Heart attacks Humans Hypertension Hypertension - diagnosis Hypertension - epidemiology Hypertension - physiopathology Hypotheses Internal Medicine Kidney diseases Lasers Male Medicine Medicine & Public Health Microcirculation - physiology Microvessels - physiopathology Middle Aged Mortality Nephrology Older people Participation R&D Renal Insufficiency, Chronic - diagnosis Renal Insufficiency, Chronic - epidemiology Renal Insufficiency, Chronic - physiopathology Research & development Research Article Risk Factors Studies Urine Vascular disease Laser Doppler flowmetry Blood pressure Endothelial function Albuminuria CKD
ISSN:	1471-2369, 1471-2369
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Shrnutí:	Background Impairment in glomerular endothelial function likely plays a major role in the development of albuminuria and CKD progression. Glomerular endothelial dysfunction may reflect systemic microvascular dysfunction, accounting in part for the greater cardiovascular risk in patients with albuminuria. Prior studies of vascular function in CKD have focused on conduit artery function or those with ESRD, and have not examined microvascular endothelial function with albuminuria. Methods We conducted a cross-sectional study among older hypertensive male veterans with stage 1–4 CKD, and hypertensive controls without CKD. Microvascular function was quantified by two distinct Laser-Doppler flowmetry (LDF) measures: peak responses to 1) post-occlusive reactive hyperemia (PORH) and 2) thermal hyperemia (TH), measured on forearm skin. Associations of each LDF measure with albuminuria, eGFR, and CKD status were estimated using correlation coefficients and multiple linear regression, accounting for potential confounders. Results Among 66 participants (mean age 69.2 years), 36 had CKD (mean eGFR 46.1 cc/min/1.73 m 2 ; 30.6 % with overt albuminuria). LDF responses to PORH and TH were 43 and 39 % significantly lower in multivariate analyses among those with macroalbuminuria compared to normoalbuminuria, (β= − 0.42, p = 0.009 and β= −0.37, p = 0.01, respectively). Those with CKD had a 23.9 % lower response to PORH compared to controls ( p = 0.02 after adjustment). In contrast, TH responses did not differ between those with and without CKD. Conclusions Microvascular endothelial function was strongly associated with greater albuminuria and CKD, independent of diabetes and blood pressure. These findings may explain in part the excess systemic cardiovascular risk associated with albuminuria and CKD.
Bibliografia:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 ObjectType-Undefined-3
ISSN:	1471-2369 1471-2369
DOI:	10.1186/s12882-016-0303-x